The gallbladder is located under the liver and near the stomach. Gallstones form when cholesterol or bile stored in the gallbladder hardens into pieces of stone-like material. Gallstones are made of cholesterol salts or bilirubin salts. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.
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Gallstones are caused when bile or cholesterol crystalizes into gallstones.
Gallstones can form under the following conditions: Too much cholesterol in the bileToo much bilirubin in the bileNot enough bile saltsWhen the gallbladder does not empty completely or often enough due to blockage or poor contraction
People who are older than 60 are at increased risk for gallstones. Women between 20-60 years old and those with high estrogen levels are also at increased risk. People of Native American, Mexican American, and Northern European descent are also at increased risk.
Other factors that may increase your risk of gallstones include:
Problems that affect the gallbladder such as:
Inflammation of the lining of the gallbladderPoor gallbladder functionDiseases of the gallbladder and ductsPrevious gallstones
Dietary factors such as a:
ObesityRapid weight loss and fastingHigh fat diet
Certain conditions such as
or Crohn's disease
Blockage in the biliary tractHistory of intestinal problems
Blood diseases that increase breakdown of hemoglobin and therefore bile production, including
sickle cell anemiaGastric bypass
Liver disease, such as cirrhosisMetabolic syndromeLack of physical activityHeredity
Certain medications can increase your risk of gallstones, including: Thiazide diureticsCholesterol-lowering drugs—fibratesCeftriaxoneOctreotideSomastatin
Many people have gallstones without symptoms, called silent gallstones. In some cases, these are treated.
Gallstones may cause pain in the upper abdomen. This is sometimes called an attack because it begins suddenly, often after a fatty meal. The pain is severe and may last for 30 minutes or several hours.
Other symptoms include: Intermittent pain on the right, below the rib cage; the pain may spreadBloating, nausea, and vomitingBelching, gas, and indigestion
If you have the following symptoms, see your doctor right away: Abdominal painSweatingChillsLow-grade feverYellowish color of the skin or whites of the eyesClay-colored stools
Talk to your doctor about the best treatment plan for you.
cholecystectomy—the removal of the gallbladder through several small incisions in the abdomen. To view the gallbladder, a small, lighted tube with a camera is inserted into one of the incisions. Surgical instruments are used to remove the gallbladder through one of the other incisions.
Open cholecystectomy—the removal of the gallbladder through a large incision in the abdomen. This is necessary if there is an infection in the abdomen or a great deal of scar tissue.
You may be prescribed: Over-the-counter or prescription medication to control painBile salt tablets to dissolve gallstones; these medications may need to be taken for months or years until the stones are dissolved
Shock wave lithotripsy—machine called a lithotripter generates shock waves that pass through the body to break the gallstone into smaller pieces
Another procedure that may be used to treat gallstones is called
endoscopic retrograde cholangiopancreatography
(ERCP). ERCP uses a combination of endoscopy and x-rays to locate and remove gallstones before or during gallbladder surgery.
Gallstones. American Academy of Family Physicians' FamilyDoctor website. Available at:
Updated March 2014. Accessed November 12, 2015.
Gallstones. National Institute of Diabetes & Digestive & Kidney Diseases website. Available at:
http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones. Updated November 27, 2013. Accessed November 12, 2015.
6/18/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114033/Gallstones: Yarmish GM, Smith MP, et al. American College of Radiology (ACR) Appropriateness Criteria on right upper quadrant pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/RightUpperQuadrantPain.pdf. Updated 2013. Accessed December 9, 2014.
Last reviewed November 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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